HESI MEDSURG1 Question and Answer
2026 | Full Practice Test Workbook with
Explanations | Grade A+
• rapid acting insulin -✓✓lispro (humalog) - 10-15 min *all peak w/in
30-60 mins
aspart (novolog) - 5-15 min
glulisine (apidra) - 5-15 min
• short acting -✓✓regular (humalog r, novolin r, iletin II regular) 1-
1.5h; peak in 2h; only insulin that can be given IV
-often mixed w/ intermediate, never with long acting
• intermediate acting -✓✓NPH (humulin n, iletin II lente, iletin II NPH,
novolin N) 2-4h; peak in 4-12h;
• very long acting -✓✓glargine (lantus) CANNOT MIX THIS.
detemis (levemir) *onset iin 1h w/ no peak
• Hypothyroidism -✓✓dec thyroid hormone; primary or secondary;
s/s: weakness, fatigue, cold intolerance, weight gain, constipation,
goiter, slow speech, dry cool skin, puffy face, dry coarse hair, thick
brittle nails
,• Cushings -✓✓adrenal hypofunction; high adrenocortical hormones;
weight gain, muscle weakness, buffalo hump, thinning extremities w/
muscle wasting, thin fragile skin, moon face, ruddy complexion,
hirsutism, truncal obesity, broad purple striae, bruising, hyperglycemia,
hyper atresia, hypokalemia, impaired wound healing; treated w/ surgery,
HTN, radiation, or drug therapy
Teach to take steroids w meals to prev GI distress, don't skip doses;
avoid infection; low sodium diet;
• Hypocalcemia s/s -✓✓
• HHNS -✓✓occurs w/ type 2 most of the time, esp older PTs;
characterized by hyperosmolarity of blood and hyperglycemia; caused
by stress; slower onset than DKA; normal pH; osmolality > 350 ( BG
usually 600-1200); BUN and creatinine elevated; higher mortality that
DKA; mental status changes, severe dehydration, postural hypotension
• DKA -✓✓Results fro insulin deficiency; features are hyperglycemia,
dehydration/electrolyte loss (diuresis), and acidosis; fat breakdown
forms free fatty acids and glycerol; rapid onset; osmolality 300-350;
BUN and creatinine elevated
• causes of DKA -✓✓Missed insulin dose, illness/infection,
undiagnosed diabetes
, • DKA clinical manifestations -✓✓Polyuria, polydipsia, fatigue;
ketonuria; pH < 7.3; n/v, dehydration, abdominal pain, kussmaul
respirations; acetone odor
• DKA PT prevention education -✓✓Take insulin as usual, BG and
urine ketones q4h, fluids (lyte replacement), report n/v/d to provider
• DKA treatment -✓✓rehydration - isotonic (NS), electrolyte
replacement (esp K), reversing acidosis (insulin drip w/ regular insulin,
not too fast bc cerebral edema)
• DM nursing assessment findings -✓✓Skin infections, non healing.
Wounds, periodontal disease, cataracts, retinopathy, angina, dyspnea,
HTN, hair loss in extremities, coolness, shiny thin skin, weak peripheral
pulses, pallor, thick nails wth ridges, edema, UTI, signs of renal failure (
edema, anorexia, nausea, fatigue, difficulty concentrating), neuropathy
(numbness, tingling, pain, burning), diarrhea at night, impotence, dry
vag, period probs, depression
• Somogyi phenomenon -✓✓dec in BG around 2-3am to hypoglycemic
levels; should dec evening insulin dose
• dawn phenomenon -✓✓normal BG until like 3am; should change time
of evening injection from dinnertime to bedtime
2026 | Full Practice Test Workbook with
Explanations | Grade A+
• rapid acting insulin -✓✓lispro (humalog) - 10-15 min *all peak w/in
30-60 mins
aspart (novolog) - 5-15 min
glulisine (apidra) - 5-15 min
• short acting -✓✓regular (humalog r, novolin r, iletin II regular) 1-
1.5h; peak in 2h; only insulin that can be given IV
-often mixed w/ intermediate, never with long acting
• intermediate acting -✓✓NPH (humulin n, iletin II lente, iletin II NPH,
novolin N) 2-4h; peak in 4-12h;
• very long acting -✓✓glargine (lantus) CANNOT MIX THIS.
detemis (levemir) *onset iin 1h w/ no peak
• Hypothyroidism -✓✓dec thyroid hormone; primary or secondary;
s/s: weakness, fatigue, cold intolerance, weight gain, constipation,
goiter, slow speech, dry cool skin, puffy face, dry coarse hair, thick
brittle nails
,• Cushings -✓✓adrenal hypofunction; high adrenocortical hormones;
weight gain, muscle weakness, buffalo hump, thinning extremities w/
muscle wasting, thin fragile skin, moon face, ruddy complexion,
hirsutism, truncal obesity, broad purple striae, bruising, hyperglycemia,
hyper atresia, hypokalemia, impaired wound healing; treated w/ surgery,
HTN, radiation, or drug therapy
Teach to take steroids w meals to prev GI distress, don't skip doses;
avoid infection; low sodium diet;
• Hypocalcemia s/s -✓✓
• HHNS -✓✓occurs w/ type 2 most of the time, esp older PTs;
characterized by hyperosmolarity of blood and hyperglycemia; caused
by stress; slower onset than DKA; normal pH; osmolality > 350 ( BG
usually 600-1200); BUN and creatinine elevated; higher mortality that
DKA; mental status changes, severe dehydration, postural hypotension
• DKA -✓✓Results fro insulin deficiency; features are hyperglycemia,
dehydration/electrolyte loss (diuresis), and acidosis; fat breakdown
forms free fatty acids and glycerol; rapid onset; osmolality 300-350;
BUN and creatinine elevated
• causes of DKA -✓✓Missed insulin dose, illness/infection,
undiagnosed diabetes
, • DKA clinical manifestations -✓✓Polyuria, polydipsia, fatigue;
ketonuria; pH < 7.3; n/v, dehydration, abdominal pain, kussmaul
respirations; acetone odor
• DKA PT prevention education -✓✓Take insulin as usual, BG and
urine ketones q4h, fluids (lyte replacement), report n/v/d to provider
• DKA treatment -✓✓rehydration - isotonic (NS), electrolyte
replacement (esp K), reversing acidosis (insulin drip w/ regular insulin,
not too fast bc cerebral edema)
• DM nursing assessment findings -✓✓Skin infections, non healing.
Wounds, periodontal disease, cataracts, retinopathy, angina, dyspnea,
HTN, hair loss in extremities, coolness, shiny thin skin, weak peripheral
pulses, pallor, thick nails wth ridges, edema, UTI, signs of renal failure (
edema, anorexia, nausea, fatigue, difficulty concentrating), neuropathy
(numbness, tingling, pain, burning), diarrhea at night, impotence, dry
vag, period probs, depression
• Somogyi phenomenon -✓✓dec in BG around 2-3am to hypoglycemic
levels; should dec evening insulin dose
• dawn phenomenon -✓✓normal BG until like 3am; should change time
of evening injection from dinnertime to bedtime
